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Transkraniell elektrisk stimulering (tDCS)

All you need to know about transcranial Direct Current Stimulation (tDCS)

tDCS, the technique used in the Flow headset, has a long history. It usually takes researchers several years to find out if a treatment is effective enough to use in medical practices. One study is not enough! On this page, you’ll find some facts about the history of tDCS and a comparison between different types of brain stimulation techniques. Have fun!

What is tDCS?

Transcranial Direct Current Stimulation (tDCS) is a gentle form of brain stimulation technique that you can use at home to treat depression (Major Depressive Disorder, MDD).

tDCS delivers a gentle electric current through two electrodes placed on the scalp. This is what a tDCS headset looks like:

When treating depression, the electrodes are placed high up on the forehead to target a brain area called the dorsolateral prefrontal cortex (DLPFC). Lowered activity in this brain area is associated with depressive symptoms such as fatigue, sleeping problems, concentration difficulties and changes in appetite. The electrical current in tDCS stimulates brain activity in the DLPFC and thereby alleviates the depressive symptoms.

A tDCS session usually lasts for about 30 minutes. The recommended protocol for depression includes 5 tDCS sessions per week during the first three weeks and, after that, 1-2 sessions per week for as long as you need it. Most people notice a reduction of their depressive symptoms within 3-4 weeks

A brief history of brain stimulation and tDCS

So far, we’ve learned that tDCS is a gentle form of brain stimulation that treats depression. But where does it come from? Is there research to support it? And does it actually work?

Here is a summary of the scientific evidence and some of the most important discoveries in tDCS history.

Ancient time: Electric fish could relieve pain

Grekiska och romerska läkare observerade att elektrisk ström kunde lindra huvudvärk och ledvärk. De använde elektriska urladdningar från darrockan, även kallad “the torpedo fish”! (Largus, 1529)

18th Century: Physicians experimented with early versions of tDCS

Vissa läkare använde det nyligen uppfunna galvaniska batteriet för att genomföra hjärnstimulering med patienter. (Zago et al., 2008)

1950s-1970s: The first modern studies of tDCS was published

Kontrollerad och systematisk forskning på elektrisk hjärnstimulering tog fart. Nya studier visade att stimuleringen kunde öka den kortikala aktiviteten i hjärnan. (Bindman et al., 1964; Purpura & McMurtry, 1965)

1970s-1980s: Medication overshadowed tDCS

Intresset för medicinsk behandling ökade och färre studier fokuserade på hjärnstimuleringens roll inom sjukvården. (Brunoni, 2012)

1998-2000: tDCS was reappraised!

Intresset för hjärnstimulering ökade igen bland forskare och tDCS återupptäcktes. Två viktiga studier visade att tDCS kunde bidra till aktivering av hjärnans kortex. (Priori et. al, 1998; Nitsche & Paulus, 2000)
Efter det användes tDCS i flera studier för att undersöka olika hjärnområden eller som behandling för psykiatriska sjukdomar.

2006: Research proved the antidepressant effects of tDCS

En RCT*- studie genomförd av Fregni och kollegor visade att tDCS kunde ha antidepressiv verkan. Nedstämdhet mättes med Hamilton Depression Rating Scale (HDRS) och minskade med 58.5% i den patientgrupp som fick tDCS-behandling, medan placebogruppens nedstämdhet minskade med 13.1%. (Fregni et. al, 2006.)

2010-2012: tDCS proved to be as effective as other depression treatments

RCT*- studier av Loo och kollegor, Palm och kollegor samt Blumberger och kollegor undersökte tDCS effekt på depression. Resultaten inkluderades i den metaanalys** som genomfördes av Brunoni och kollegor 2016 och som visade att tDCS var jämförbar med rTMS och antidepressiv medicin vid behandling av depression inom primärvården. (Loo et. al, 2010; Palm et. al, 2012; Loo et. al, 2012; Blumberger et. al, 2012; Brunoni et al., 2016)

2012: Experts recommended tDCS as depression treatment

  • Kalu and colleagues performed a meta-analysis** of earlier studies, suggesting that tDCS has antidepressant effects, at the same time noting that future studies should use larger patient samples for clearer results. (Kalu et. al, 2012)

  • Brunoni and colleagues concluded that tDCS is a suitable treatment for depression and can be used in clinical practice because the technique is noninvasive, has a low rate of side effects, is low-cost and portable.

“tDCS is a technique with a low rate of reported side effects, relatively easy to apply and less expensive than other neuromodulatory techniques — appealing characteristics for clinical use. In the past years, 4 of 6 phase II clinical trials and one recent meta-analysis have shown positive results in ameliorating depression symptoms.”

Brunoni et. al, 2012

2013: Researchers found tDCS and medication to be a powerful combination

Brunoni och kollegor genomförde en RCT*- studie. Forskarna upptäckte att genom att kombinera tDCS och antidepressiv medicin blev båda behandlingarna mer effektiva. Medelvärdespoängerna på Montgomery-Asberg Depression Rating Scale (MADRS) skilde sig signifikant åt mellan den behandlingsgrupp som fick medicin kombinerat med tDCS och den behandlingsgrupp som enbart fick medicin (genomsnittlig skillnad: 8.5 poäng). Poängerna skilde sig även signifikant åt mellan den kombinerade behandlingsgruppen och gruppen som enbart fick tDCS (genomsnittlig skillnad: 5.9 poäng) och mellan den kombinerade behandlingsgruppen och placebogruppen (genomsnittlig skillnad: 11.5 poäng). (Brunoni et. al, 2013)

2016: Researchers proved that tDCS is 100% safe to use

  • Brunoni and colleagues performed a meta-analysis**, showing that tDCS was comparable to rTMS and antidepressant medication when treating depression in primary care. (Brunoni et. al, 2016)

  • Through a meta-analysis**, Bikson and colleagues found that tDCS is safe to use and has never been associated with brain damage.

“To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations.”

Bikson et. al, 2016

2017: Again, tDCS proved to be much more effective than placebo

Brunoni och kollegor upptäckte att 41% av deprimerade personer upplevde att minst hälften av deras symptom försvann inom 6 veckor med tDCS-behandling. Bara 22% av placebogruppen rapporterade liknande resultat. (Brunoni et. al, 2017)

2018: Researchers found the most effective ways to use tDCS

  • Nikolin and colleagues performed a meta-analysis** showing that tDCS is safe to use and that injuries do not increase with higher levels of tDCS exposure. (Nikolin et. al, 2018)

  • Pavlova and colleagues found that a combination of tDCS and antidepressant medication is an effective treatment for mild to moderate depression. Also, a treatment with 30-minute stimulation sessions is more effective than one with 20-minute sessions. (Pavlova et. al, 2018)

  • Loo and colleagues conducted an RCT* study and found no difference between depressed participants given active tDCS treatment (2,5 mA) and those given sham tDCS (0.034 mA and two 60-second current ramp ups to 1 and 0.5 mA). According to the researchers, one possible explanation for the finding was that the weak current in the sham group affected participants’ moods. (Loo et. al, 2018)

2019: tDCS was found to be as effective, but less expensive than other treatments

  • Mutz and colleagues compared different types of brain stimulation techniques to find out if they should be used as treatments for depression. The researchers found tDCS to be efficacious and a less expensive treatment than TMS, ECT or psychotherapy.

“…we found tDCS to be efficacious across outcomes in both pairwise and network meta-analyses. Given that tDCS tends to be a less expensive treatment than transcranial magnetic stimulation, ECT, or psychotherapy, this finding is particularly relevant for policy makers who might consider tDCS as a clinical therapy outside the research setting.”

Mutz et. al, 2019

*RCT (Randomised Controlled Trial) är en typ av forskningsmetod som används för att säkerställa att resultaten blir så pålitliga som möjligt.

**En metaanalys är en forskningsmetod som kombinerar resultat från flera olika studier. Detta innebär att resultaten från en metaanalys är extra pålitliga.

Modern brain stimulation techniques

What is transcranial direct current stimulation (tDCS) and how is it different from other forms of brain stimulation? Hopefully, these questions can help clear things up.

What do tDCS, TMS and ECT look like?

What is tDCS, TMS and ECT?

tDCS: Transcranial direct current stimulation (tDCS) is a non-invasive, non-pharmacological and painless form of brain stimulation.

TMS: Transcranial magnetic stimulation (TMS) is a non-invasive and non-pharmacological form of brain stimulation.

ECT: Electroconvulsive Therapy (ECT) induces a generalised seizure in the brain to relieve symptoms of severe psychiatric disorders.

What drives the stimulation?

tDCS: Electric current.

TMS: Electromagnetic induction.

ECT: Electric current.

Where is tDCS, TMS and ECT used?

tDCS: tDCS is approved for treating depression and chronic pain in the EU, including the UK. It’s available for home use. Flow Neuroscience offers the first medically approved device for at-home depression treatment.

TMS: In 2009, TMS was approved by the US Food and Drug Administration (FDA) for depression treatment. Today, TMS is used in hospitals in the UK, the USA and Sweden.

ECT: ECT is used both in the EU and the USA to treat the most severe cases of depression. The technique is very different from tDCS and can only be used in hospitals under general anesthesia.

How do the techniques work?

tDCS: tDCS delivers a weak direct current (0,5-2 mA) to specific brain areas via electrodes placed on the scalp. It helps the cortex of the brain become more easily excited. tDCS can be used at home or at health care clinics.

TMS: Instead of direct electric current, TMS uses electromagnetic fields to alter the activity in specific areas of the brain’s cortex. TMS is administered by healthcare professionals and doesn’t require anesthesia.

ECT: An electric current passes through the brain to induce a generalised seizure in anesthetized patients. The current used in ECT is 400 times stronger than with tDCS and should only be used to treat the most severe cases of depression.

What brain area is stimulated?

tDCS: In the treatment of depression, the electrodes are placed to target the DLPFC (dorsolateral prefrontal cortex) of the brain.

TMS: TMS targets basically the same brain area as tDCS in depression treatment, that is the DLPFC (dorsolateral prefrontal cortex).

ECT: In the treatment of depression, electrodes are most commonly placed over the temporal cortex of the brain on both sides of the scalp.

What are the side effects from tDCS, TMS and ECT?

tDCS: Side effects are less severe than those from medication, TMS and ECT. 

Side effects include mild stinging sensations under the electrodes and mild headaches that pass after 30 minutes.

TMS: Side effects are less severe than those from medication or ECT. Side effects include headaches and a small risk of seizures.

ECT: Side effects include confusion, memory loss and physical pain.

Is it available for home use?

tDCS: Yes

TMS: No

ECT: No

Why should I trust Flow Neuroscience?

Det behöver du inte. Flow har granskats av externa experter på uppdrag av the British Standards Institution (BSI). Flows headset är CE-certifierat och medicinskt godkänt inom EU. För att få ett sådant godkännande måste tillverkaren bevisa att enheten är kliniskt ekvivalent. Det betyder att oberoende experter på hjärnstimulering och hälsoteknik har undersökt headsetet och försäkrat sig om att det fungerar på samma sätt som de enheter som används i forskningsstudierna. CE-certifieringen säkerställer att Flow baseras på vetenskapliga bevis, att behandlingen minskar depressiva symptom och att headsetet är ofarligt att använda.

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